Light blogging today, I’m afraid. My high speed Internet access was on the fritz last night, leaving odds and ends. Truly annoying. (On the other hand, maybe it’s the FSM’s way of telling me to slow down a bit.)

Patch Adams, the famous doctor who advocates humor in medicine and has been known to dress up in a clown outfit, as shown in the movie starring Robin Williams, displayed a distinctly non-amusing side of his personality in a speech at Vanderbilt University last month:

Patch Adams, M.D., an unconventional doctor who became a household name through a 1998 movie starring Robin Williams, unloaded on government and medicine while advocating love and compassion as medical treatments to Vanderbilt School of Medicine students attending a two-hour lecture Oct. 25 in Light Hall.

Sporting partially blue hair with a non-matching tie and accompanying outfit, the founder of the Gesundheit! Institute called President George Bush and Vice President Dick Cheney “mass murderers,” predicted VUSM’s doctors-in-training will live to see the extinction of the human race and advised the physicians-in-training to withhold prescribing psychotropic medications for mental illness patients.

“Our government is worse than Hitler because they are making decisions that can make us extinct,” Adams said.

“We need to find a way to not put murderous people in charge … they are heinous, they are mass murderers. They even told us to call it Shock and Awe.”

I was half tempted to sic the Hitler Zombie on him for that one, but didn’t bother; it was too uncreative and common (i.e., booooring!) an invocation of Hitler to catch the Undead Führer’s attention. And, if that was all he said, I wouldn’t have mentioned it anyway. It’s just politics, and people say ridiculous things about politics all the time. This what Adams said that was truly disturbing:

Adams caught the attention of Scott Rodgers, M.D., assistant dean of Students, when he labeled depression as a “selfish act” and spoke against the use of psychotropic medications as treatment.

“To me depression is a symptom of a disease called loneliness,” Adams said. “You cannot be depressed and hold someone you love in your mind at the same time — it is impossible.”

Rodgers, a psychiatrist who has seen many patients with mental illness, labeled the speaker’s advice as ‘malpractice.’

“I was shocked and dismayed to hear a famous and influential physician speak in this way about mental illness,” Rodgers said.

Indeed. It’s just plain ignorant to say such things. Depression is a disease. You can have the most loving, committed family in the world and still suffer from depression. To say otherwise and urge medical students not to use antidepressants to treat depression is not just ignorant, it’s advocating malpractice. If future physicians were to heed such advice, it could result in more patient deaths from suicide.

I’ve always been of a somewhat divided mind on the things “Patch” spoke about. Certainly, depression is oppressive and often as debilitating as any pathogen, but at the same time I don’t think anyone would disagree that antidepressants are vastly over-prescribed for the “worried well.”

I’m also a big advocate for the touchy-feely spiritual side of medicine. I truly believe that my surgeon’s bedside manner easily did as much to help me heal as all my surgeries. However, I will always despise the invocation of the doctors-as-gestapo metaphor. Hospitals often must walk a tense line between caring for patients and appeasing their insurance companies, and surely there are many doctors who view their patients as little more than a collection of problems, but as I’ve tried to explain to many people before, doctors really do want to help you, believe it or not.

Certainly, depression is oppressive and often as debilitating as any pathogen, but at the same time I don’t think anyone would disagree that antidepressants are vastly over-prescribed for the “worried well.”

Adams didn’t say that antidepressants are overprescribed. If that’s what he had said, depending on the context, I probably wouldn’t have had an issue with him. No, he said that depression is a “selfish” act, as if the truly clinically depressed could somehow will themselves out of depression without pharmacologic intervention if they weren’t so “selfish” or “lonely.” Anyone who’s dealt with patients with depression, either as a physician, family member, or friend, knows that’s usually not the case.

No, what Adams said is idiotic, medically incorrect, and dangerous to patients with real organic depression, plain and simple. What a twit. And that’s even excluding his having had his brain chomped by the Hitler Zombie.

Depression impairs your ability to see your problems objectively and form a rational plan of action. People with hypothermia can’t recognize their danger and need others to help them. In the depths of despair, you can’t ‘pull yourself together’.

How depressing to hear something so judgmental (depressives are selfish) from someone who is supposed to be so compassionate.

I’ve been reading up on depression recently as my oldest son (15) was diagnosed with it and just started taking anti-depressants this week. It was very hard for him to make the decision to take them. I don’t think I will be sharing this article with him.

According to Adams, “You cannot be depressed and hold someone you love in your mind at the same time — it is impossible.” A large corpus of romantic poetry argues otherwise. “Oh, my Lolita, I have only words to play with. . . .“

“You cannot be depressed and hold someone you love in your mind at the same time — it is impossible.”

Well, yes. But that’s because depression can screw up your ability to feel love toward someone or to feel that you are loved, not because love can cure depression. It’s not a character flaw; it’s a symptom of a very real disease. Instead of berating people for not being loving enough, why not give them the treatment they need so they can feel love again?

When people talk about refusing to prescribe/use drugs for depression or trying to get by without treatment, I feel the need to remind everyone that depression is in fact a potentially life-threatening illness. Taking it lightly is dangerous.

In our extended family there is someone with bipolar disease. Sometimes her behavior can be described as “selfish”. In her depressive states there is nothing her very loving parents and siblings can do to her satisfaction. Nothing is good enough, and it hurts her family. In her manic states she goes on a spending spree, despite having no income (so her parents again help her pay her bills).

She insisted on going to a naturapath who prescribed homeopathy and diet changes, plus she went on the internet where she self-diagnosed herself with an alphabet load of “conditions”.

Then during a manic stage she had a psychotic episode and was sent to the county hospital’s psych ward. There she got the dianosis of “bipolar”, was put on meds and given talk therapy. She was released as a well person.

But because of the lack of psych followup she went back to the naturapath, stop taking the real meds and started up with homeopathic remedies. She actually learned the “value” of homeopathy when the mental state swings started again.

So she is back on real meds. She is better, but still needs more help from professionals which is not coming because she has no insurance and is not a “danger to herself or others”.

Now this really pisses me off. I didn’t care for the movie “Patch Adams” (for a variety of reasons, all unrelated to the real person) but I never thought of the guy himself as in any way a mean person.

But this? This is mean. This is cruel. And it’s outrageously unscientific. Having dealt with recurrent clinical depression, I can attest that it’s not your fault if you’re depressed, and being loving can’t fix it. For one thing, if you’re depressed, it’s gonna be awfully difficult to be loving. Hell, a lot of seriously depressed folks start contemplating killing themselves as a favor to their loved ones. That’s how messed up it can make you.

Telling a depressed one that they’re selfish is not quite the worst thing you can possibly do to them. But it’s right up there on the list. Odds are, it’s something they’ve already thought. “Why am I so pathetic that I can’t even be happy with my life?” And along comes Patch Adams to reinforce that self-destructive illogic. Wonderful medicine.

Perhaps he’s gotten so tied up in the “laughter as medicine” concept that he’s fallen prey to the altie pitfall of “if it’s not working, it’s the patient’s fault for not trying hard enough” (a particularly harsh reaction when we’re talking depression). Or perhaps he’s one of those people who is happy all the time, can’t understand depression, and doesn’t understand that the difference between comedy and tragedy is extremely slight.

One other thing about what he said. How can modern physicians be alive to witness the extinction of the human race? The human race is not extinct until all humans are dead, after all. :p

Maybe Dr. Adams should get together with Tom Cruise to discuss depression? Hey, I know that before I found medication, people telling me stuff like “You’re smart, attractive, have a wonderful husband, great children, and a lovely home – what could you possibly be depressed about?” was probably the worst thing I could hear, and sent me back into a hiding place where I could bawl my eyes out for being so ungrateful. Yep, tell patients they’re selfish. It’ll save a lot of time and money on treatment, because many of them will kill themselves instead of finding a more compassionate, competent doctor.

Jonathan Dobres: Certainly, depression is oppressive and often as debilitating as any pathogen, but at the same time I don’t think anyone would disagree that antidepressants are vastly over-prescribed for the “worried well.”

Color me dubious… even the modern antidepressants (SSRIs and variants) tend to have seriously annoying side effects. Of course, this is a major step up from the older types (MAOIs and tricyclics), whose side-effects could be life-threatening…. And for all of the above, if you’re not depressed, you won’t get anything but side-effects from taking them!

“The principles of effective medication management include proper assessment, diagnosis, prescription, and monitoring for efficacy as well as for potential side effects….First, a good clinical assessment was performed, and a working diagnosis was determined. When the initial assessment and plan proved to be ineffective, other solutions were sought. Medications that were potentially ineffective, of marginal utility, or that might be adding to side effects were stopped. Eventually, the correct medication–in this case an antidepressant–was initiated, and the patient improved.”

Incidentally, the case above involved a patient admitted for what had appeared, at first glance, to be fully somatic problems. The patient was fortunate to have such competent and professional care, rather than knee-jerk anti-psych reactionaries like Dr. Adams.

It is also possible that Dr. Adams is a scientologist, since he seems far more concerned about (as yet undocumented) overprescription of anti-depressants than the well documented overprescription of antibiotics or the inappropriate use of anti-cholinergic agents in demented patients, to cite two very real medication management issues of great importance. And note that even in those cases, no physician in his right mind would advocate *never* using antibiotics or *always* avoiding medications with anti-cholinergic pharmacodynamics.

To advocate that physicians should stop prescribing a particular class of medications altogether, absent extreme and convincing evidence of unacceptable harm that outweighs any benefits (or lack of evidence of benefit), goes beyond the realm of unprofessional and crosses over into criminally negligent.

Sorry about the previous post. Sometimes the urge to be a smartass can’t be resisted.
Anyway, I did a bit of checking Wikipedia about Patch Adams. His bio states that he is a supporter of the antipsychiatry movement. His speech is certainly consistent with it. But antipsychiatry??? Man, that was getting old when I graduated from medical school too many years ago to admit.
Besides which, clowns are in fact evil…

I remember a lecturer telling us that untreated depression has a higher mortality rate than some some physical illnesses that are universally acknowledged to be ‘serious conditions’. He also argued that the co-morbidities of depression are linked to chronic illnesses that have a further viciously debilitating impacts on the quality of life. Who knew it was really selfishness that is responsible for these corrosive effects?

I have shed many a tear over the recent events that have occured at Vanderbilt. I witnessed the opening of a CAM center there and have caught wind of the scourge of subsequent speakers and programs that have sprung forth because of it. Adams is an idiot. The movie about him was a joke, just not a funny one. I wish I had been there for his speech.

The guy’s an ass. I didn’t go to Patch Adams day at last year’s big Erickson Evolution Of Psychotherapy conference in Anaheim (I did go to the talks of Seligman, Albert Ellis, and other worthies)…but I felt the effects of his disingenuous and wrong thinking when some man marched over to the table where I was sitting and stuck his big paw out to feel up my computer shell (a zebra pattern from Macskinz.com).

I was shocked. If you’re my friend, you can probably grab my ass and I’ll just laugh. If I don’t know you…don’t fucking touch me or my stuff.

I turned to the guy and said, “Excuse me, you’re a psychotherapist, aren’t you?” (Most people there were — and about every tenth person looked batshit crazy.) “How come,” I continued, “People in France will always say ‘Excuse me, but may I ask you about your (rather interestingly patterned) computer’ and ask if they can touch it, but Americans have a tendency to march over and grab it?”

Naturally, the guy didn’t have a good answer, but I his friend piped in, “We’re all together here.”

I noticed he was wearing a Patch Adams badge — from the session where they all gave each other group hugs. “I see you went to the Patch Adams day…with the group hugs,” I said. “Well, if you’re my friend, I’ll come with you to chemo and bring you snacks and a cashmere sweater…but I’m just not a group hug kinda girl!”

Sorry to take the long road, but the point is, in “group hugs” there’s a level of bullshit, just like there is in the Patch Adams remarks above. I’m a very good friend, but if I don’t know you, I don’t love you, and I don’t want to hug you, and how many of those people didn’t think twice about the fat old man with bad bread standing next to them giving them a big grab?

David: I’m not saying that a portion of the people being prescribed antidepressants don’t “need” them, per se. If you are depressed, then certainly an antidepressant will help with that most of the time, regardless of the degree of your depression (placebo effects notwithstanding). And naturally, one cannot begin to address a person’s depression in talk therapy if the person is too withdrawn to communicate. My point was that it seems some clinicians are a little trigger happy when it comes to prescribing these types of medications to people with milder and possibly more acute mood problems.

Regardless, Patch advocating that doctors withhold psychotropic drugs from their patients is akin to saying that they should withhold insulin from diabetics.